What, exactly, is a ‘supplement’? In the minds of many people, the term ‘supplement’ is synonymous with vitamins and/or minerals. Vitamins and minerals are known to be necessary for good health, and supplementation is generally understood as a means of getting from pills or drops important health-promoting substances lacking in one’s diet. But today, supplements refer to a wide array of substances, not just vitamins and minerals, purported to address needs which go far beyond maintaining adequate nutrition. From anti-aging to performance enhancement, dietary supplements have grown from a niche market within the domain of complementary and alternative medicine (CAD) to a multi-billion dollar industry with cosmetic, fitness, memory, and other applications. According to a recent study in the American Journal of Epidemiology, it is estimated that as many as 52% of Americans take some form of dietary supplement on a regular basis.(1) Do you? Should you? If so, which ones? In this discussion, I will attempt to answer some of the most common questions asked regarding nutritional supplements, and to provide a framework for understanding the risks, benefits, and limitations of supplementation as a tool for improving health and well-being.What is the difference between a medicine and a supplement? For fun take this short quiz; after each of the following four statements mark a ‘T’ if you believe the statement to be true, or an ‘F’ if you believe it to to be false: 1. Drugs are synthetically manufactured in laboratories, while supplements are naturally occurring substances, harvested or gathered for consumption. T/F 2. Drugs always carry the risk of side effects, while supplements are benign and, generally speaking, carry little to no risk of side effects. T/F 3. Drugs weaken the body by taking over the work normally done by our own cells while supplements strengthen the body by providing our cells with the nutrition they need to work better. T/F 4. Drugs, in addition to having side effects, are often toxic to vital organs such as the liver, especially when taken over long periods of time; supplements, by contrast, are excreted in the urine and are generally not toxic. While each of these statements contains a kernel of truth, they are, in fact, technically all false. Yes, drugs are typically synthetically manufactured, but so are many supplements including most vitamins. It is true that drugs always carry the risk of side effects, but so do all supplements. Consider the following list of symptoms: nausea, vomiting, diarrhea, flushing, headache, fatigue, insomnia, and skin rash. If these were the list of side effects associated with a drug prescribed by your doctor, would you hesitate when filling that prescription? In fact, these are the most common side effects associated with high-dose Vitamin C supplementation! Drugs can weaken us, especially when administered too soon or inappropriately (such as when antibiotics are wrongly prescribed for colds), but supplements can weaken us too; high dosing of certain vitamins lowers our ability to absorb and utilize those nutrients through a process known as down-regulation. And while toxicity issues exist for most medicines, the same is true of many supplements. For example, fat soluble vitamins such as A, D, and E, are stored in our fatty tissues, including the liver, and too high doses over time can cause liver damage. Perhaps most importantly, while the manufacturing of drugs is strictly regulated for purity, cleanliness, and consistency by the FDA, supplements are under no such regulatory mandate. The result is that many supplements contain contaminants and/or are inconsistent in their dosing which can lead to toxicity. This is actually legal! A manufacturer’s use of terms such as, “standardized,” “certified,” or “verified” does not legally guarantee the purity, quality, or consistency of a nutritional supplement. Before a drug can be brought to market in the United States, it must be tested for safety, reliability, and efficacy according to extremely rigorous protocols and high standards set by the FDA. By contrast, the only real limitation on the manufacturing and sale of supplements is that the product label information may not be knowingly misleading. And even this marginal regulatory control can be easily circumvented. Manufacturers can make virtually any claim about a supplement as long as the label contains the following disclaimer, “These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease.” Hour-long infomercials and other other powerful marketing tools containing extravagant claims about the power of supplements to restore joint health, reverse aging, promote fat burning, increase libido, or even cure diseases, are legal, even if there is no scientific basis for such claims, provided this disclaimer is included. The result is that many supplements on today’s market have little or no clinical efficacy and some may actually be harmful. In an unregulated market it is difficult to separate what works and is safe from what does not work and/or is harmful. In this discussion I will offer some guidelines for how to tell the difference.If supplements can be dangerous, should I just stay away from them altogether? No. As in other areas of life, not all manufacturers of nutritional supplements are alike. Some manufacturers, despite the lack of legal requirement for regulation and oversight, take great pains to follow the same rigorous standards set by the FDA for drugs to provide consistent, clean, reliable, safe products. Naturally, this raises production cost, but paying a little more for a safe, clean, reliable product is worth it, especially today when many nutritional supplements are manufactured overseas, often using laboratories and machinery which are unclean by domestic standards. In some cases different products are produced using the same machinery causing supplements to contain traces of drugs, herbs, or various other by-products which are left behind. Some supplements, especially herbal formulas, have been shown to contain anti-inflammatory medicines, stimulants, or other drugs purposely added to provide specific physiological effects such as pain reduction and increased energy. The presence of these substances are not disclosed on the label and users of these products often attribute their effects (falsely) to the herbs. Cleanliness, substance purity, and reliability of dosing are all important elements to be considered when choosing a brand of supplements. The key is to choose the right brand.Author: Dr. Gregory Berkoff